Provider Demographics
NPI:1528331964
Name:GOLDSBY, FELICIA MICHELLE (BA, MBA, COTA)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:MICHELLE
Last Name:GOLDSBY
Suffix:
Gender:F
Credentials:BA, MBA, COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 OLIVE ST STE 400
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-2303
Mailing Address - Country:US
Mailing Address - Phone:314-206-3700
Mailing Address - Fax:
Practice Address - Street 1:1740 KOCH DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-3104
Practice Address - Country:US
Practice Address - Phone:314-830-1163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010026227224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0606278547OtherCASE MANAGER
MO2010026227OtherSTATE OF MISSOURI, MISSOURI BOARD OF HEALING ARTS